Increasing the Supply of Primary Care Physicians

Sarah Kliff has an informative article about what medical schools and the federal government are trying to do to increase the supply of primary care physicians. It’s informative in part because it explains at great length that nobody seems to be trying or even considering trying any of the most obvious steps, which I would classify as:

—Build a new medical school and have it only train primary care physicians. Getting into medical school is hard—much harder than it was 40 years ago; if we let more people in we’ll have more doctors.

—Change immigration laws to allow for unlimited entry of foreign-born primary care physicians. If we’re worried about “brain drain,” we can work out a scheme to automatically deduct 2 percent of the doctors’ income and send it back to their home country.

—Reduce the Medicare reimbursement rates for specialists, so as to decrease the financial incentive for students to avoid becoming primary care physicians.

I don’t really understand why none of these ideas are on the table, since they really do seem like the obvious ones. The immigration option deserves more explication because a lot of people don’t understand the full implications of it. The main point isn’t simply that some of the world’s existing stock of doctors could be diverted to the United States. Doctors command higher wages in the United States than elsewhere, while at the same time many foreign countries have a substantial cost advantage in providing medical training. If you establish a clear path by which a foreign-born, foreign-trained individual can receive a work permit and a medical license, then this will inspire the developing world to train more doctors, many of whom will move to the United States. Allowing for more trade allows for more specialization and more overall production. Currently you’re allowed to build physical objects in whichever country is best-suited to building physical objects and then sell them in whichever country has the most demand for the objects. But legally speaking, doctors generally need to be produced in the countries that consume their services. This makes no sense as in practice the countries with the highest demand for medical services are the countries where it’s most expensive to produce new doctors.

The other idea would be to allow more of the functions of the present-day primary care physician to be undertaken by nurses. My most recent visit to a doctor’s office was extremely pleasant, but my physician did something I’d never seen a doctor do before—she looked something up on her computer. Computers should, over time, be more and more powerful diagnostic tools and nurse + computer could be patients’ primary point of contact with the health care system unless something goes badly wrong.